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Cervical Disc Replacement or Fusion? Surgery for arm and neck pain, numbness, tingling and weakness from neck arthritis, disc herniation (slipped disc) and radiculopathy
Last updated Tuesday, June 09, 2009
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SummaryOverview Edited By: Michael J. Lee, M.D.
A commonly performed surgery for the treatment of a symptomatic herniated disc (“slipped disc”) is an anterior cervical discectomy and fusion (ACDF) (Figure 1). This operation involves removing part of the disc between the cervical vertebrae (neck bones), and fusing (surgically uniting) the adjacent vertebrae together. While this is effective in the treatment of symptoms of arm and neck pain, numbness, tingling and weakness, which often occur in patients with arthritis of the cervical spine (neck), there are some concerns about the possible longer-term effects of having the vertebrae (bones) of the neck fused together.
Imagine having a knee fusion. This operation, which is very occasionally done for treatment of severe infections that can’t be treated any other way, involves removing the joint at the knee and attaching the thigh bone (femur) to the shin bone (tibia), eliminating motion at the joint. At the end of the operation, the knee is locked in an extended (nearly) straight position. Though running difficulties not possible, walking usually is, but the absence of the joint increases the load seen by the other joints in the leg (including the hip and the ankle). Over time, those joints may become arthritic and Painful.
The same thing occurs in the spine. When two vertebrae of the neck are fused, the levels above and below see altered forces and motion, and this appears to give rise to degeneration (arthritis) at levels next to those fused. This is known as adjacent-segment degenerative disease.
Adjacent segment degeneration has been the driving force for the development of cervical total disc replacement (TDR). Total disc replacement in the neck is analogous in some ways to joint replacements elsewhere in the body, such as hip replacements or knee replacements, but there are some special issues unique to joint replacement in the neck, which this article will cover.
TDR is a new technology used to treat herniated discs (“slipped discs”) in the neck (Figures 2 & 3), which can arise. While both total disc replacement and the procedure described earlier (anterior cervical discectomy and fusion) remove the herniated disc, the fusion replaces the disc with bone, while TDR replaces it with a mobile implant (a joint replacement) designed to preserve motion. While in theory, this can prevent the occurrence of adjacent segment disease, long-term data is not yet available and this has not definitively been shown to be the case.
A herniated disc (“slipped disc”) or advanced osteoarthritis in the neck can narrow the space where the nerve root branches off of the spinal cord. This in turn creates pressure on the nerve roots. This pressure and accompanying inflammatory reaction causes pain, numbness, tingling, and weakness. There are other causes of this problem, but arthritis or a herniated disc are by far the most common.
When a nerve root or a branch off of the spinal cord is affected, the condition is termed radiculopathy. Radiculopathy can be treated with surgical and nonsurgical measures, including anterior cervical discectomy and fusion, or, in certain instances, total disc replacement
When the condition affects the spinal cord, it is termed myelopathy. In general, myelopathy in the cervical spine (neck) is a very serious condition, and frequently it is treated surgically; in very mild cases, myelopathy can be observed.
Both anterior cervical discectomy and fusion, as well as total disc replacement have been shown to be highly successful in relieving symptoms of radiculopathy.
Surgery for Cervical Radiculopathy at the University of Washington, Department of Orthopaedics and Sports Medicine, Seattle, Washington If you are interested in making an appointment to discuss this procedure in Seattle, you can request an appointment using our online referrals website. To request a referral online, please click here. You can also call 206-598-4288 to make an appointment. Our clinical center is located in Seattle Washington, USA
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